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Elzoghby MM, Salama MMA, Elsetiha MA, El Ahwal HM, Romeih SA, Shaaban MN, Elmozy WE. Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study. J Magn Reson Imaging 2024; 59:2265-2274. [PMID: 37772452 DOI: 10.1002/jmri.29026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear. PURPOSE To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT. STUDY TYPE Prospective. SUBJECTS 50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years). FIELD STRENGTH/SEQUENCE 1.5T with balanced steady-state free precession cine sequence. ASSESSMENT Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory. STATISTICAL TESTS Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level. RESULTS Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208). DATA CONCLUSION Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Mohamed M Elzoghby
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mai M A Salama
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Elsetiha
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hanan M El Ahwal
- Radiodiagnosis Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Soha A Romeih
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mahmoud N Shaaban
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Wesam E Elmozy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
- Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Treutlein C, Zeilinger MG, Dittrich S, Roth JP, Wetzl M, Heiss R, Wuest W, May MS, Uder M, Rompel O. Free-Breathing and Single-Breath Hold Compressed Sensing Real-Time MRI of Right Ventricular Function in Children with Congenital Heart Disease. Diagnostics (Basel) 2023; 13:2403. [PMID: 37510147 PMCID: PMC10377861 DOI: 10.3390/diagnostics13142403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Purpose: to compare right ventricular (RV) functional parameters in children with surgically repaired congenital heart disease (CHD) using single/double breath hold (BH) and free-breathing (FB) real-time compressed sensing (CS) cine cardiac magnetic resonance (cMRI) with standard retrospective segmented multi breath hold (RMB) cine cMRI. (2) Methods: Twenty patients with CHD underwent BH and FB, as well as RMB cine cMRI, at 3T to obtain a stack of continuous axial images of the RV. Two radiologists independently performed qualitative analysis of the image quality (rated on a 5-point scale; 1 = non-diagnostic to 5 = excellent) and quantitative analysis of the RV volume measurements. (3) Results: The best image quality was provided by RMB (4.5; range 2-5) compared to BH (3.9; range 3-5; p = 0.04) and FB (3.6; range 3-5; p < 0.01). The RV functional parameters were comparable among BH, FB, and RMB with a difference of less than 5%. The scan times for BH (44 ± 38 s, p < 0.01) and FB (24 ± 7 s, p < 0.01) were significantly reduced compared to for RMB (261 ± 68 s). (4) Conclusions: CS-FB and CS-BH real-time cine cMRI in children with CHD provides diagnostic image quality with excellent accuracy for measuring RV function with a significantly reduced scan time compared to RMB.
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Affiliation(s)
- Christoph Treutlein
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Martin Georg Zeilinger
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Jan-Peter Roth
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Matthias Wetzl
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | | | - Matthias Stefan May
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Oliver Rompel
- Institute of Radiology, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Chattopadhyay A, Singhal M, Debi U, Bhal A, Sharma A, Jain S. Prevalence and pattern of myocardial involvement on cardiac magnetic resonance imaging in Takayasu arteritis and its relationship with disease activity. REUMATOLOGIA CLINICA 2023; 19:6-11. [PMID: 36603966 DOI: 10.1016/j.reumae.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiac involvement in Takayasu arteritis (TA) is the major cause of morbidity and mortality. Cardiovascular magnetic resonance (CMR) is an excellent modality for the assessment of myocardial involvement. Studies have shown myocardial involvement in 25%-27% of patients. OBJECTIVES To evaluate the prevalence and pattern of myocardial involvement in TA on CMR. We also evaluated any correlation between CMR changes and disease activity score (ITAS 2010 and ITAS-A) assessed at the time of CMR. METHODS Patients classified as Takayasu arteritis according to Sharma et al. criteria were enrolled in the study. Demographic, clinical, and laboratory data were documented in the predesigned proforma. CMR was performed on a dedicated cardiac 3Tesla MR machine. Disease activity was recorded by ITAS2010 and ITAS-A. RESULTS A total of 37 TA patients were included. Mean (±SD) age was 29±11 years. Female to male ratio was 3:1. Five patients (14%) had myocardial involvement on CMR. Two (2/5) had myocarditis and three (3/5) patients had features of ischaemic myocardial fibrosis. CONCLUSION The myocardium is affected in TA, however the prevalence of subclinical myocardial involvement in our study was less (8% vs. 25%-27%) compared to the previous studies. Myocardial involvement trends towards early age of onset, less disease duration, lack of classical risk factors, and more with disease activity.
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Affiliation(s)
- Arghya Chattopadhyay
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Uma Debi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bhal
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Huang S, Li Y, Shi K, Wang J, Jiang L, Gao Y, Yan WF, Yang ZG. Impact of Metabolic Syndrome on Left Ventricular Deformation and Myocardial Energetic Efficiency Compared Between Women and Men: An MRI Study. J Magn Reson Imaging 2022; 57:1743-1751. [PMID: 36196628 DOI: 10.1002/jmri.28455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic and hemodynamic alterations in metabolic syndrome (MetS) can cause a reduced myocardial energetic efficiency (MEE). Indexed MEE (MEEi), as a simple estimate of MEE, is emerging as a novel and useful imaging parameter. PURPOSE To investigate the impact of MetS on MEE and systolic myocardial strain and to assess any sex difference. STUDY TYPE Retrospective. POPULATION A total of 161 patients with MetS (female: n = 82, 52.2 ± 11.7 years; male: n = 79, 51.8 ± 10.6 years) and 77 healthy subjects (female: n = 46, 52.7 ± 8.2 years; male: n = 31, 54.1 ± 11.2 years). Patients with left ventricular (LV) ejection fraction <50% were excluded. FIELD STRENGTH/SEQUENCE A 3.0 T; balanced steady-state free precession sequence. ASSESSMENT LV volumes and mass (LVM) and global longitudinal strain (GLS) were obtained by MRI. Stroke volume (SV) divided by HR was used as a surrogate measure of MEE and normalized to LVM (MEEi). STATISTICAL TESTS Student's t-test or Mann-Whitney U-test; Multivariable linear regression (coefficient of determination, R2 ). P < 0.05 was considered statistically significant. RESULTS For both males and females, MEEi and GLS were lower in MetS patients than in the normal controls. Among MetS patients, men had significantly higher LVM (59.7 ± 13.4 g/m2 vs. 48.8 ± 11.3 g/m2 ) and significantly lower MEEi (0.68 ± 0.23 mL/g/s vs. 0.84 ± 0.23 mL/g/s) and GLS (-11.7% ± 2.8% vs. -13.9% ± 2.7%) than women. After adjustment for clinical variables, male gender (β = -0.291) was found to be inversely correlated with MEEi. Multivariable analysis showed that MEEi (β = 0.454) were independently associated with GLS (adjusted R2 = 0.454) after adjustment for clinical and other MRI parameters. DATA CONCLUSION MEEi was significantly impaired in MetS without overt systolic dysfunction. There was a sex difference regarding the cardiac alterations in MetS, with men having significantly lower MEEi and GLS and significantly higher LVM than women. Further, MEEi was independently associated with GLS. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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Park E, Griffin J, Bathon JM. Myocardial Dysfunction and Heart Failure in Rheumatoid Arthritis. Arthritis Rheumatol 2022; 74:184-199. [PMID: 34523821 PMCID: PMC8795468 DOI: 10.1002/art.41979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) patients have almost twice the risk of heart failure (HF) as individuals without RA, even with adjustment for the presence of ischemic heart disease. Moreover, RA patients remain at a 2-fold higher risk of mortality from HF compared to non-RA patients. These observations suggest that RA-specific inflammatory pathways are significant contributors to this increased risk of HF. Herein we summarize the epidemiology of HF in RA patients, the differences in myocardial structure or function between RA patients and non-RA patients without clinical signs of HF, and data on the role of systemic and local inflammation in RA HF pathophysiology. We also discuss the impact of subduing inflammation through the use of RA disease-modifying therapies on HF and myocardial structure and function, emphasizing gaps in the literature and areas needing further research.
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Affiliation(s)
- Elizabeth Park
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Jan Griffin
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Joan M Bathon
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
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7
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Meinel TR, Eggimann A, Brignoli K, Wustmann K, Buffle E, Meinel FG, Scheitz JF, Nolte CH, Gräni C, Fischer U, Kaesmacher J, Seiffge DJ, Seiler C, Jung S. Cardiovascular MRI Compared to Echocardiography to Identify Cardioaortic Sources of Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:699838. [PMID: 34393979 PMCID: PMC8362907 DOI: 10.3389/fneur.2021.699838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/30/2021] [Indexed: 01/21/2023] Open
Abstract
Background: To compare the diagnostic yield of echocardiography and cardiovascular MRI (CMR) to detect structural sources of embolism, in patients with ischemic stroke with a secondary analysis of non-stroke populations. Methods and Results: We searched MEDLINE/Embase (from 01.01.2000 to 24.04.2021) for studies including CMR to assess prespecified sources of embolism. Comparison included transthoracic and/or transesophageal echocardiography. Two authors independently screened studies, extracted data and assessed bias using the QUADAS-2 tool. Estimates of diagnostic yield were reported and pooled. Twenty-seven studies with 2,525 patients were included in a study-level analysis. Most studies had moderate to high risk of bias. Persistent foramen ovale, complex aortic plaques, left ventricular and left atrial thrombus were the most common pathologies. There was no difference in the yield of left ventricular thrombus detection between both modalities for stroke populations (4 studies), but an increased yield of CMR in non-stroke populations (28.1 vs. 16.0%, P < 0.001, 10 studies). The diagnostic yield in stroke patients for detection of persistent foramen ovale was lower in CMR compared to transoesophageal echocardiography (29.3 vs. 53.7%, P < 0.001, 5 studies). For both echocardiography and CMR the clinical impact of the management consequences derived from many of the diagnostic findings remained undetermined in the identified studies. Conclusions: Echocardiography and CMR seem to have similar diagnostic yield for most cardioaortic sources of embolism except persistent foramen ovale and left ventricular thrombus. Randomized controlled diagnostic trials are necessary to understand the impact on the management and potential clinical benefits of the assessment of structural cardioaortic stroke sources. Registration: PROSPERO: CRD42020158787.
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Affiliation(s)
- Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Angela Eggimann
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Kristina Brignoli
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Department of Cardiology, Inselspital Bern, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eric Buffle
- Department of Cardiology, Inselspital Bern, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jan F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik für Neurologie, Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik für Neurologie, Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany
| | - Christoph Gräni
- Department of Cardiology, Inselspital Bern, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital Bern, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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8
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Keenan NG, Captur G, McCann GP, Berry C, Myerson SG, Fairbairn T, Hudsmith L, O'Regan DP, Westwood M, Greenwood JP. Regional variation in cardiovascular magnetic resonance service delivery across the UK. Heart 2021; 107:1974-1979. [PMID: 33766986 PMCID: PMC8639953 DOI: 10.1136/heartjnl-2020-318667] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine service provision in cardiovascular magnetic resonance (CMR) in the UK. Equitable access to diagnostic imaging is important in healthcare. CMR is widely available in the UK, but there may be regional variations. METHODS An electronic survey was sent by the British Society of CMR to the service leads of all CMR units in the UK in 2019 requesting data from 2017 and 2018. Responses were analysed by region and interpreted alongside population statistics. RESULTS The survey response rate was 100% (82 units). 100 386 clinical scans were performed in 2017 and 114 967 in 2018 (15% 1-year increase; 5-fold 10-year increase compared with 2008 data). In 2018, there were 1731 CMR scans/million population overall, with significant regional variation, for example, 4256 scans/million in London vs 396 scans/million in Wales. Median number of clinical scans per unit was 780, IQR 373-1951, range 98-10 000, with wide variation in mean waiting times (median 41 days, IQR 30-49, range 5-180); median 25 days in London vs 180 days in Northern Ireland). Twenty-five units (30%) reported mean elective waiting times in excess of 6 weeks, and 8 (10%) ≥3 months. There were 351 consultants reporting CMR, of whom 230 (66%) were cardiologists and 121 (34%) radiologists; 81% of units offered a CMR service for patients with pacemakers and defibrillators. CONCLUSIONS This survey provides a unique, contemporary insight into national CMR delivery with 100% centre engagement. The 10-year growth in CMR usage at fivefold has been remarkable but heterogeneous across the UK, with some regions still reporting low usage or long waiting times which may be of clinical concern.
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Affiliation(s)
- Niall G Keenan
- Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, Hertfordshire, UK .,MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Gabriella Captur
- University College London Institute of Cardiovascular Science, London, UK.,Centre for Inherited Heart Muscle Conditions, Royal Free Hospital, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Timothy Fairbairn
- Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, Merseyside, UK
| | - Lucy Hudsmith
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, West Midlands, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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9
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Guo X, Cao Y, Cao J, Li X, Liu P, Wang Z, Gao L, Bao X, Xing B, Wang Y. Reversibility of Cardiac Involvement in Acromegaly Patients After Surgery: 12-Month Follow-up Using Cardiovascular Magnetic Resonance. Front Endocrinol (Lausanne) 2020; 11:598948. [PMID: 33193111 PMCID: PMC7609918 DOI: 10.3389/fendo.2020.598948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/02/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cardiac comorbidity is one of the leading causes of death among acromegaly patients. We aimed to investigate the reversibility of acromegalic cardiac involvement after surgical treatment using the gold standard method, cardiovascular magnetic resonance, and to explore the effects of endocrine remission and gender on reversibility. METHODS In this single-center, prospective cohort study, fifty untreated acromegaly patients were enrolled. Comprehensive cardiac assessments were performed using a 3.0 T magnetic resonance scanner before and 3 and 12 months after transsphenoidal adenomectomy. RESULTS Preoperatively, left ventricular (LV) enlargement (13.0%), LV systolic dysfunction (6.5%), right ventricular (RV) enlargement (4.3%), RV systolic dysfunction (2.2%) and myocardial fibrosis (12.0%) were identified. On average, the LV and RV ejection fractions of acromegaly patients were higher than the healthy reference values. Male patients had thicker LV myocardia, wider ventricular diameters and more dilated pulmonary artery roots than female patients. After surgery, LV myocardial hypertrophy was reversed, the left atrium was remodeled, and ventricular systolic dysfunction recovered to normal. Cardiac alterations were detected early in the 3rd postoperative month and persisted until the 12th month. The interventricular septum was initially thickened in the 3rd postoperative month and then recovered at the 12th month. Notable postoperative cardiac reversibility was observed in male patients but did not occur in all female patients. Patients achieving endocrine remission with normalized hormone levels had thinner LV myocardia than patients without normalized hormone levels. CONCLUSION Our findings demonstrated that some of the cardiac involvement in acromegaly patients is reversible after surgical treatment which lowers hormone levels. Endocrine remission and gender significantly impacted postoperative cardiac reversibility.
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Affiliation(s)
- Xiaopeng Guo
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yihan Cao
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Cao
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Li
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peijun Liu
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihao Wang
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Lu Gao
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Xinjie Bao
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Bing Xing
- Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Centre, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
- *Correspondence: Bing Xing, ; Yining Wang,
| | - Yining Wang
- Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Bing Xing, ; Yining Wang,
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10
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Marín Rodríguez C, Álvarez Martín T, Lancharro Zapata Á, Ruiz Martín Y, Sánchez Alegre M, Delgado Carrasco J. Evolution and trends in a pediatric cardiac magnetic resonance imaging program in a tertiary hospital over a 14-year period. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Evolución y tendencias de un programa de resonancia magnética cardiaca pediátrica en un hospital terciario durante 14 años. RADIOLOGIA 2019; 61:489-497. [DOI: 10.1016/j.rx.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/18/2019] [Accepted: 05/03/2019] [Indexed: 11/17/2022]
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12
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De Rubeis G, Galea N, Ceravolo I, Dacquino GM, Carbone I, Catalano C, Francone M. Aortic valvular imaging with cardiovascular magnetic resonance: seeking for comprehensiveness. Br J Radiol 2019; 92:20170868. [PMID: 30277407 PMCID: PMC6732913 DOI: 10.1259/bjr.20170868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic valve disease evaluation, becoming an all-in-one technique. CMR evaluation of the anatomy and flow through the aortic valve has a higher reproducibility than echocardiography. Its unique ability of in vivo myocardial tissue characterization, significantly improves the risk stratification and management of patients. In addition, CMR is equivalent to cardiac CT angiography for trans-aortic valvular implantation and surgical aortic valve replacement planning; on the other hand, its role in the evaluation of ventricular function improving and post-treatment complications is undisputed. This review encompasses the existing literature regarding the role of CMR in aortic valve disease, exploring all the aspects of the disease, from diagnosis to prognosis.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | | | - Isabella Ceravolo
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Gian Marco Dacquino
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
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13
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Michel M, Shabanah W, Körperich H, Kelter-Klöpping A, Entenmann A, Racolta A, Laser KT. Left ventricular mass estimation by real-time 3D echocardiography favourably competes with CMR in congenital left ventricular disease. Sci Rep 2019; 9:11888. [PMID: 31417137 PMCID: PMC6695417 DOI: 10.1038/s41598-019-48375-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022] Open
Abstract
Assessment of left ventricular mass (LVM) is important in the evaluation of patients with congenital heart disease (CHD) and cardiac magnetic resonance imaging (CMR) is the gold standard. Recent software allows LVM calculation by real-time 3-dimensional echocardiography (RT3DE). We investigated the impact of different software analysis tools on LVM determination by CMR or RT3DE in a cohort of patients with heterogeneous left ventricular (LV) disease. 37 subjects (17 patients, mean age 18.7 y; 20 controls, mean age 13.2 y) underwent CMR and RT3DE. CMR LVM and RT3DE calculations were done using two different LV-analysis software packages for each modality: CMR i) customized software “CMR HDZ”, CMR ii) “CMR ISP”; RT3DE i) “Toshiba”, RT3DE ii) “Tomtec”, 4D LV-Analysis Version 3.1 (built 3.1.0.258661). Intra- and interobserver variabilities were calculated. Only RT3DE-derived LVM showed significant software-dependent differences. RT3DE-derived LVM (both softwares) was significantly higher than CMR-derived LVM (both softwares). The two different methods and four evaluation software packages for LVM assessment were well correlated with each other. Intra- and interobserver variability of LVM as assessed by each single modality or software was low. Despite software dependency and overestimation of RT3DE-assessed LVM by 5 to 10%, RT3DE still competes with the gold standard, CMR, even in patients with various forms of LV disease. The use of optimized software, especially for RT3DE, should improve the accuracy of LVM assessment, overcoming LVM overestimation.
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Affiliation(s)
- Miriam Michel
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria. .,Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
| | - Wael Shabanah
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Andrea Kelter-Klöpping
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Northrhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Andreas Entenmann
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca Racolta
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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14
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Otten J, Andersson J, Ståhl J, Stomby A, Saleh A, Waling M, Ryberg M, Hauksson J, Svensson M, Johansson B, Olsson T. Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. J Am Heart Assoc 2019; 8:e010634. [PMID: 30652528 PMCID: PMC6497343 DOI: 10.1161/jaha.118.010634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
Background The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12-week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function. Methods and Results Twenty-two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard-care exercise recommendations ( PD ) or to a Paleolithic diet plus supervised exercise training 3 hours per week ( PD - EX ). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD - EX group showed significant decreases in myocardial triglycerides levels (-45%, P=0.038) and left ventricle mass to end-diastolic volume ratio (-13%, P=0.008) while the left ventricle end-diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group. Conclusions Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01513798.
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Affiliation(s)
- Julia Otten
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Jonas Andersson
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Jens Ståhl
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Andreas Stomby
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Ahmed Saleh
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Maria Waling
- Department of Food and NutritionUmeå UniversityUmeåSweden
| | - Mats Ryberg
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Jon Hauksson
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Department of Radiography and Biomedical ScienceFaculty of MedicineUniversity of IcelandReykjavikIceland
| | - Michael Svensson
- Sports Medicine UnitDepartment of Community Medicine and RehabilitationUmeå UniversityUmeåSweden
| | - Bengt Johansson
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Tommy Olsson
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
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15
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Le TT, Tan RS, De Deyn M, Goh EPC, Han Y, Leong BR, Cook SA, Chin CWL. Cardiovascular magnetic resonance reference ranges for the heart and aorta in Chinese at 3T. J Cardiovasc Magn Reson 2016; 18:21. [PMID: 27071974 PMCID: PMC4830061 DOI: 10.1186/s12968-016-0236-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/22/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) reference ranges have not been well established in Chinese. Here we determined normal cardiac and aortic reference ranges in healthy Singaporean Chinese and investigated how these data might affect clinical interpretation of CMR scans. METHODS In 180 healthy Singaporean Chinese (20 to 69 years old; males, n = 91), comprehensive cardiac assessment was performed using the steady state free precision technique (3T Ingenia, Philips) and images were analysed by two independent observers (CMR42, Circle Cardiovascular Imaging). Measurements were internally validated using standardized approaches: left ventricular mass (LVM) was measured in diastole and systole (with and without papillary muscles) and stroke volumes were compared in both ventricles. All reference ranges were stratified by sex and age; and "indeterminate/borderline" regions were defined statistically at the limits of the normal reference ranges. Results were compared with clinical measurements reported in the same individuals. RESULTS LVM was equivalent in both phases (mean difference 3.0 ± 2.5 g; P = 0.22) and stroke volumes were not significantly different in the left and right ventricles (P = 0.91). Compared to females, males had larger left and right ventricular volumes (P < 0.001 for all). Indexed LVM was significantly higher in males compared to females (50 ± 7 versus 38 ± 5 g/m2, respectively; P < 0.001). Overall, papillary muscles accounted for only ~2% of the total LVM. Indexed atrial sizes and aortic root dimensions were similar between males and females (P > 0.05 for all measures). In both sexes, age correlated negatively with left and right ventricular volumes; and positively with aortic sinus and sinotubular junction diameters (P < 0.0001 for all). There was excellent agreement in indexed stroke volumes in the left and right ventricles (0.1±5.7 mL/m2, 0.7±6.2 mL/m2, respectively), LVM (0.6±6.4 g/m2), atrial sizes and aortic root dimensions between values reported in clinical reports and our measured reference ranges. CONCLUSIONS Comprehensive sex and age-corrected CMR reference ranges at 3T have been established in Singaporean Chinese. This is an important step for clinical practice and research studies of the heart and aorta in Asia.
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Affiliation(s)
- Thu-Thao Le
- />National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Ru San Tan
- />National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Michelle De Deyn
- />Trinity College Dublin, School of Medicine, Dublin, Republic of Ireland
| | | | - Yiying Han
- />National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Bao Ru Leong
- />National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
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16
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Sayin O, Saybasili H, Zviman MM, Griswold M, Halperin H, Seiberlich N, Herzka DA. Real-time free-breathing cardiac imaging with self-calibrated through-time radial GRAPPA. Magn Reson Med 2016; 77:250-264. [PMID: 26969611 DOI: 10.1002/mrm.26112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/29/2015] [Accepted: 12/12/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Real-time free-breathing cardiac imaging with highly undersampled radial trajectories has previously been successfully demonstrated using calibrated radial generalized autocalibrating partially parallel acquisition (rGRAPPA). A self-calibrated approach for rGRAPPA is proposed that removes the need for the calibration prescan. METHODS To investigate the effect of various parameters on image quality, a comprehensive imaging study on one normal swine was performed. Root mean squared errors (RMSEs) were computed with respect to gold standard acquisitions, and several acquisition/reconstruction strategies were compared. Additionally, the method was tested on 13 human subjects, and RMSEs relative to standard through-time radial GRAPPA were computed. RESULTS Real-time images with high spatiotemporal resolution were obtained. Image quality was comparable to calibrated through-time rGRAPPA with endocardial and epicardial borders clearly delineated. In the swine, the average RMSE between self-calibrated and gold-standard calibrated images was 5.18 ± 0.84%. In normal human subjects, the average RMSE between self-calibrated and calibrated through-time rGRAPPA was 3.79 ± 0.64%. For lower accelerations rates (R = 6-8) image quality was similar to comparable calibrated scans though RMSE increased for higher degrees of undersampling (R = 12-16). CONCLUSION Highly accelerated real-time imaging with undersampled radial trajectories without additional calibration data is feasible. Image quality was acceptable for real-time cardiac MRI applications demanding high speed. Magn Reson Med 77:250-264, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ozan Sayin
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - M Muz Zviman
- Department of Medicine, Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark Griswold
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Henry Halperin
- Department of Medicine, Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Seiberlich
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel A Herzka
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Riffel JH, Andre F, Maertens M, Rost F, Keller MGP, Giusca S, Seitz S, Kristen AV, Müller M, Giannitsis E, Korosoglou G, Katus HA, Buss SJ. Fast assessment of long axis strain with standard cardiovascular magnetic resonance: a validation study of a novel parameter with reference values. J Cardiovasc Magn Reson 2015; 17:69. [PMID: 26253220 PMCID: PMC4529700 DOI: 10.1186/s12968-015-0171-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/16/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Assessment of longitudinal function with cardiovascular magnetic resonance (CMR) is limited to measurement of systolic excursion of the mitral annulus (MAPSE) or elaborate strain imaging modalities. The aim of this study was to develop a fast assessable parameter for the measurement of long axis strain (LAS) with CMR. METHODS 40 healthy volunteers and 125 patients with different forms of cardiomyopathy were retrospectively analyzed. Four different approaches for the assessment of LAS with CMR measuring the distance between the LV apex and a line connecting the origins of the mitral valve leaflets in enddiastole and endsystole were evaluated. Values for LAS were calculated according to the strain formula. RESULTS LAS derived from the distance of the epicardial apical border to the midpoint of the line connecting the mitral valve insertion points (LAS-epi/mid) proved to be the most reliable parameter for the assessment of LAS among the different approaches. LAS-epi/mid displayed the highest sensitivity (81.6 %) and specificity (97.5 %), furthermore showing the best correlation with feature tracking (FTI) derived transmural longitudinal strain (r = 0.85). Moreover, LAS-epi/mid was non-inferior to FTI in discriminating controls from patients (Area under the curve (AUC) = 0.95 vs. 0.94, p = NS). The time required for analysis of LAS-epi/mid was significantly shorter than for FTI (67 ± 8 s vs. 180 ± 14 s, p < 0.0001). Additionally, LAS-epi/mid performed significantly better than MAPSE (Delta AUC = 0.09; p < 0.005) and the ejection fraction (Delta AUC = 0.11; p = 0.0002). Reference values were derived from 234 selected healthy volunteers. Mean value for LAS-epi/mid was -17.1 ± 2.3 %. Mean values for men were significantly lower compared to women (-16.5 ± 2.2 vs. -17.9 ± 2.1 %; p < 0.0001), while LAS decreased with age. CONCLUSIONS LAS-epi/mid is a novel and fast assessable parameter for the analysis of global longitudinal function with non-inferiority compared to transmural longitudinal strain.
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Affiliation(s)
- Johannes H Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Malte Maertens
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Franziska Rost
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Marius G P Keller
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Sorin Giusca
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Sebastian Seitz
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Arnt V Kristen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Matthias Müller
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Grigorios Korosoglou
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany.
| | - Sebastian J Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
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18
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Jackson T, Claridge S, Behar J, Sammut E, Webb J, Carr-White G, Razavi R, Rinaldi CA. Narrow QRS systolic heart failure: is there a target for cardiac resynchronization? Expert Rev Cardiovasc Ther 2015; 13:783-97. [PMID: 26048215 DOI: 10.1586/14779072.2015.1049945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac resynchronization therapy has revolutionized the management of systolic heart failure in patients with prolonged QRS during the past 20 years. Initially, the use of this treatment in patients with shorter QRS durations showed promising results, which have since been opposed by larger randomized controlled trials. Despite this, some questions remain, such as, whether correction of mechanical dyssynchrony is the therapeutic target by which biventricular pacing may confer benefit in this group, or are there other mechanisms that need consideration? In addition, novel techniques of cardiac resynchronization therapy delivery such as endocardial and multisite pacing may reduce potential detrimental effects of biventricular pacing, thereby improving the benefit/harm balance of this therapy in some patients.
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Affiliation(s)
- Tom Jackson
- Department of Cardiovascular Imaging, 4th Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
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19
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Roberts AM, Ware JS, Herman DS, Schafer S, Baksi J, Bick AG, Buchan RJ, Walsh R, John S, Wilkinson S, Mazzarotto F, Felkin LE, Gong S, MacArthur JAL, Cunningham F, Flannick J, Gabriel SB, Altshuler DM, Macdonald PS, Heinig M, Keogh AM, Hayward CS, Banner NR, Pennell DJ, O'Regan DP, San TR, de Marvao A, Dawes TJW, Gulati A, Birks EJ, Yacoub MH, Radke M, Gotthardt M, Wilson JG, O'Donnell CJ, Prasad SK, Barton PJR, Fatkin D, Hubner N, Seidman JG, Seidman CE, Cook SA. Integrated allelic, transcriptional, and phenomic dissection of the cardiac effects of titin truncations in health and disease. Sci Transl Med 2015; 7:270ra6. [PMID: 25589632 PMCID: PMC4560092 DOI: 10.1126/scitranslmed.3010134] [Citation(s) in RCA: 338] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The recent discovery of heterozygous human mutations that truncate full-length titin (TTN, an abundant structural, sensory, and signaling filament in muscle) as a common cause of end-stage dilated cardiomyopathy (DCM) promises new prospects for improving heart failure management. However, realization of this opportunity has been hindered by the burden of TTN-truncating variants (TTNtv) in the general population and uncertainty about their consequences in health or disease. To elucidate the effects of TTNtv, we coupled TTN gene sequencing with cardiac phenotyping in 5267 individuals across the spectrum of cardiac physiology and integrated these data with RNA and protein analyses of human heart tissues. We report diversity of TTN isoform expression in the heart, define the relative inclusion of TTN exons in different isoforms (using the TTN transcript annotations available at http://cardiodb.org/titin), and demonstrate that these data, coupled with the position of the TTNtv, provide a robust strategy to discriminate pathogenic from benign TTNtv. We show that TTNtv is the most common genetic cause of DCM in ambulant patients in the community, identify clinically important manifestations of TTNtv-positive DCM, and define the penetrance and outcomes of TTNtv in the general population. By integrating genetic, transcriptome, and protein analyses, we provide evidence for a length-dependent mechanism of disease. These data inform diagnostic criteria and management strategies for TTNtv-positive DCM patients and for TTNtv that are identified as incidental findings.
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Affiliation(s)
- Angharad M Roberts
- Clinical Sciences Centre, Medical Research Council (MRC), Imperial College London, London W12 0NN, UK. National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - James S Ware
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK. Department of Genetics, Harvard Medical School, Boston, MA 02115, USA. Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Daniel S Herman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA. Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA. Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Sebastian Schafer
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
| | - John Baksi
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Alexander G Bick
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA. Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Rachel J Buchan
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Roddy Walsh
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Shibu John
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Samuel Wilkinson
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Francesco Mazzarotto
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Leanne E Felkin
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Sungsam Gong
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Jacqueline A L MacArthur
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SD, UK
| | - Fiona Cunningham
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SD, UK
| | - Jason Flannick
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA. Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stacey B Gabriel
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - David M Altshuler
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA. Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter S Macdonald
- Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia. Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia. Faculty of Medicine, University of New South Wales, Kensington, New South Wales 2052, Australia
| | - Matthias Heinig
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
| | - Anne M Keogh
- Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia. Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia. Faculty of Medicine, University of New South Wales, Kensington, New South Wales 2052, Australia
| | - Christopher S Hayward
- Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia. Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia. Faculty of Medicine, University of New South Wales, Kensington, New South Wales 2052, Australia
| | - Nicholas R Banner
- National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK. Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK
| | - Dudley J Pennell
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Declan P O'Regan
- Clinical Sciences Centre, Medical Research Council (MRC), Imperial College London, London W12 0NN, UK
| | - Tan Ru San
- National Heart Centre Singapore, Singapore 169609, Singapore
| | - Antonio de Marvao
- Clinical Sciences Centre, Medical Research Council (MRC), Imperial College London, London W12 0NN, UK
| | - Timothy J W Dawes
- Clinical Sciences Centre, Medical Research Council (MRC), Imperial College London, London W12 0NN, UK
| | - Ankur Gulati
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Emma J Birks
- National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK. Department of Medicine, University of Louisville and Jewish Hospital, Louisville, KY 40202, USA
| | - Magdi H Yacoub
- National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Michael Radke
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, 13092 Berlin, Germany
| | - Michael Gotthardt
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, 13092 Berlin, Germany. German Centre for Cardiovascular Research, 13347 Berlin, Germany
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA 01702, USA. Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - Sanjay K Prasad
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK
| | - Paul J R Barton
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College London, London SW3 6NP, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Diane Fatkin
- Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia. Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales 2010, Australia. Faculty of Medicine, University of New South Wales, Kensington, New South Wales 2052, Australia
| | - Norbert Hubner
- Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany. German Centre for Cardiovascular Research, 13347 Berlin, Germany. Charité-Universitätsmedizin, 10117 Berlin, Germany
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA. Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142, USA. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
| | - Stuart A Cook
- Clinical Sciences Centre, Medical Research Council (MRC), Imperial College London, London W12 0NN, UK. National Heart & Lung Institute, Imperial College London, London SW3 6NP, UK. National Heart Centre Singapore, Singapore 169609, Singapore. Duke-National University of Singapore, Singapore 169857, Singapore.
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Rinta-Kiikka I, Tuohinen S, Ryymin P, Kosonen P, Huhtala H, Gorgels A, Bayés de Luna A, Nikus K. Correlation of electrocardiogram and regional cardiac magnetic resonance imaging findings in ST-elevation myocardial infarction: a literature review. Ann Noninvasive Electrocardiol 2014; 19:509-23. [PMID: 25201553 DOI: 10.1111/anec.12210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging. METHODS The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy. RESULTS Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments. CONCLUSION No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.
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Dundon BK, Torpey DK, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. Beneficial cardiovascular remodeling following arterio-venous fistula ligation post-renal transplantation: a longitudinal magnetic resonance imaging study. Clin Transplant 2014; 28:916-25. [DOI: 10.1111/ctr.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin K. Dundon
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - David K. Torpey
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Adam J. Nelson
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Dennis T. L. Wong
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Rae F. Duncan
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Randall J. Faull
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Stephen G. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
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22
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Hegde S, Bhat V, Gadabanahalli K, Kuppuswamy M. MDCT Derived Left Ventricular Function in Relation to Echocardiography: Validation and Revising the Role with the Evolving Technology. J Cardiovasc Echogr 2014; 24:18-24. [PMID: 28465899 PMCID: PMC5353405 DOI: 10.4103/2211-4122.132280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is a frequently performed examination for coronary artery disease. When performed with retrospective gating, there is an opportunity to derive functional parameters of left ventricle utilizing automated software. Complementary information, if validated with established standards, will enhance the total value of study. OBJECTIVE Study evaluates the usefulness of fully automated software for the assessment of left ventricular ejection fraction (LVEF) using 64-slice CCTA data and to correlate CT results with echocardiography (ECHO). Role of CT derived LV function is reviewed in the light of emerging technologies and recent developments in multidetector CT (MDCT). MATERIALS AND METHODS A total of 113 patients referred for MDCT CCTA for evaluation of coronary artery disease. All patients were scanned on 64 slice GE-Helical CT scanner and had an ECHO done within 1 week of the CT scan. Retrospectively electrocardiogram (ECG)-correlated image reconstruction was performed with the reconstruction at 10% R-R interval increment. Axial image sets were analyzed with advanced workstation using a program-Auto ejection fraction, Circulation: GE Medical Solutions. RESULTS The mean LVEF calculated by clinical ECHO was 58.6 ± 4.5% and by fully automated software based on CTA data was 58.9 ± 5.4%. The Pearson's regression analysis showed a large correlation, with a correlation coefficient of 0.503 (P < 0.001). Bland-Altman analysis showed a trend towards MDCT resulting in slightly higher values for LVEF when compared with ECHO. CONCLUSION The fully automated software is simple, reliable, and user-friendly, and can provide rapid assessment of LV functional parameters with good reproducibility. Despite of good correlation, fewer patients are likely to benefit, in future, from this function due to smaller number of patients undergoing CCTA with retrospective gating.
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Affiliation(s)
- Shilpa Hegde
- Department of Imaging Services, Narayana Health, Bommasandra, Bangalore, Karnataka, India
| | - Venkatraman Bhat
- Department of Imaging Services, Narayana Health, Bommasandra, Bangalore, Karnataka, India
| | - Karthik Gadabanahalli
- Department of Imaging Services, Narayana Health, Bommasandra, Bangalore, Karnataka, India
| | - Murugan Kuppuswamy
- Department of Imaging Services, Narayana Health, Bommasandra, Bangalore, Karnataka, India
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Goldfarb JW, Arnold-Anteraper S. Water-fat separation imaging of the heart with standard magnetic resonance bSSFP CINE imaging. Magn Reson Med 2013; 71:2096-104. [PMID: 23904254 DOI: 10.1002/mrm.24879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/18/2013] [Accepted: 06/18/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To study balanced steady-state free precession CINE phase-sensitive water-fat separation imaging in four cardiac imaging planes to determine the necessary phase correction and image artifacts particular to this technique. METHODS Ten healthy volunteers and two subjects with known heart pathologies were studied with standard balanced steady-state free precession CINE imaging. Water-only and fat-only images were calculated using sign detection of the real part of the complex image after phase correction with constant and linear terms. Phase correction values were determined using both manual and automated methods. Differences in phase correction values between imaging planes, cardiac phases, coil elements, automated image reconstruction parameters as well as artifact scores between the automated and manual methods were studied with statistical tests. RESULTS Water-fat separation performed well in the heart after constant and linear phase correction. Both constant (p = 0.8) and linear x (p = 1) and y (p = 1) phase correction values did not vary significantly across cardiac phases, but varied significantly among the coils (p < 0.001) and imaging planes (p < 0.001). False water-fat separation artifacts were most frequent in the chest/back and also were present at the mitral and aortic valves. CONCLUSION Constant and linear phase correction is necessary to provide consistent results in standard imaging planes using a balanced steady-state free precession water-fat separation postprocessing algorithm applied to standard cardiac CINE imaging.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, Saint Francis Hospital, Roslyn, New York, USA; Program in Biomedical Engineering, SUNY Stony Brook, Stony Brook, New York, USA
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Lu YL, Connelly KA, Dick AJ, Wright GA, Radau PE. Automatic functional analysis of left ventricle in cardiac cine MRI. Quant Imaging Med Surg 2013; 3:200-9. [PMID: 24040616 PMCID: PMC3759139 DOI: 10.3978/j.issn.2223-4292.2013.08.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/02/2013] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES A fully automated left ventricle segmentation method for the functional analysis of cine short axis (SAX) magnetic resonance (MR) images was developed, and its performance evaluated with 133 studies of subjects with diverse pathology: ischemic heart failure (n=34), non-ischemic heart failure (n=30), hypertrophy (n=32), and healthy (n=37). MATERIALS AND METHODS The proposed automatic method locates the left ventricle (LV), then for each image detects the contours of the endocardium, epicardium, papillary muscles and trabeculations. Manually and automatically determined contours and functional parameters were compared quantitatively. RESULTS There was no significant difference between automatically and manually determined end systolic volume (ESV), end diastolic volume (EDV), ejection fraction (EF) and left ventricular mass (LVM) for each of the four groups (paired sample t-test, α=0.05). The automatically determined functional parameters showed high correlations with those derived from manual contours, and the Bland-Altman analysis biases were small (1.51 mL, 1.69 mL, -0.02%, -0.66 g for ESV, EDV, EF and LVM, respectively). CONCLUSIONS The proposed technique automatically and rapidly detects endocardial, epicardial, papillary muscles' and trabeculations' contours providing accurate and reproducible quantitative MRI parameters, including LV mass and EF.
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Affiliation(s)
- Ying-Li Lu
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kim A. Connelly
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
- Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexander J. Dick
- Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Graham A. Wright
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, ON, Canada
| | - Perry E. Radau
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Ylänen K, Poutanen T, Savikurki-Heikkilä P, Rinta-Kiikka I, Eerola A, Vettenranta K. Cardiac Magnetic Resonance Imaging in the Evaluation of the Late Effects of Anthracyclines Among Long-Term Survivors of Childhood Cancer. J Am Coll Cardiol 2013; 61:1539-47. [DOI: 10.1016/j.jacc.2013.01.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/21/2012] [Accepted: 01/08/2013] [Indexed: 12/27/2022]
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Donekal S, Lima JAC. The Role of MRI in Assessing Risk of Future Cardiovascular Disease Events, Including Heart Failure. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tacke CE, Romeih S, Kuipers IM, Spijkerboer AM, Groenink M, Kuijpers TW. Evaluation of cardiac function by magnetic resonance imaging during the follow-up of patients with Kawasaki disease. Circ Cardiovasc Imaging 2012. [PMID: 23197079 DOI: 10.1161/circimaging.112.976969] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although histopathologic studies suggest persistent myocardial abnormalities after Kawasaki disease (KD), the long-term effects on cardiac function remain to be revealed. We investigated biventricular volumes, function, and the presence of myocardial fibrosis by cardiac magnetic resonance imaging during long-term follow-up of KD. METHODS AND RESULTS Sixty patients with a history of KD (mean age, 16.9 years; 67% men; median interval after KD onset, 11.6 years) and 20 healthy control subjects (mean age, 17.9 years; 55% men) 12 to 24 years of age underwent cardiac magnetic resonance imaging. Biventricular end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were determined. Volumetric measurements were indexed for body surface area. Late contrast enhancement was used to detect areas of myocardial fibrosis. Biventricular volumes and function did not differ significantly between patients and control subjects. There were also no significant differences between patients with and without a history of left ventricular dysfunction resulting from KD-associated myocarditis or between patients with and without coronary artery aneurysms. Only those with prior ischemic heart disease had a significantly lower left ventricular ejection fraction compared with unaffected KD cases (left ventricular ejection fraction, 51% versus 57%; P=0.012). Late contrast enhancement was observed in only 2 patients with severe coronary artery aneurysms and was typical for myocardial infarction. CONCLUSIONS In this cardiac magnetic resonance imaging study evaluating the cardiac function of patients with KD at long-term follow-up, we did not observe a difference in cardiac function between KD patients and control subjects, except for a subgroup of patients with ischemic heart disease as a result of severe coronary artery pathology.
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Affiliation(s)
- Carline E Tacke
- Departments of Pediatric Hematology, Immunology, and Infectious Diseases, Academic Medical Center, Amsterdam, Netherlands.
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Yeboah J, Rodriguez CJ, Stacey B, Lima JA, Liu S, Carr JJ, Hundley WG, Herrington DM. Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the multi-ethnic study of atherosclerosis (MESA). Circulation 2012; 126:2713-9. [PMID: 23124035 DOI: 10.1161/circulationaha.112.112201] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the prevalence, associations, and prognosis of individuals with asymptomatic left ventricular systolic dysfunction (ALVSD), especially in populations without previous clinical cardiovascular disease (CVD). METHODS AND RESULTS Kaplan-Meier and Cox proportional hazard analyses were used to assess the association between ALVSD, defined as left ventricular ejection fraction <50%, and adjudicated incident congestive heart failure (CHF), all-cause mortality, and CVD events. Of 5004 participants, 112 participants had CHF, 321 had a CVD event, and 278 died after 9 years of follow-up. The overall prevalence of ALVSD was 1.7%, with a higher prevalence in blacks (2.6%). ALVSD had a worse cardiovascular risk profile and was also associated with increased risk in unadjusted and adjusted models for incident CHF (HR [hazard ratio] [95% CI {confidence interval}]: 12.0 [7.04-20.3], P<0.0001 and 8.69 [4.89-15.45], P<0.001 respectively), CVD (HR [95% CI]: 3.32 [1.98-5.58], P<0.001 and 2.21 [1.30-3.73], P=0.003 respectively), and all-cause mortality (HR [95% CI]: 3.47 [2.03-5.94], P<0.0001 and 2.00 [1.13-3.54], P=0.017, respectively). A 10% decrement in left ventricular ejection fraction at baseline was associated with an increase in risk in unadjusted and adjusted models for clinical CHF (HR [95% CI]: 2.17 [1.82-2.63], P<0.0001 and 2.13 [1.73-2.51], P<0.001, respectively) and all-cause mortality (HR [95% CI]: 1.22 [1.05-1.41], P=0.009 and 1.17 [1.00-1.36], P=0.047, respectively). Among the subset of participants with ALVSD, the left ventricular mass index was particularly informative about risk for incident CHF (c-index=0.74). CONCLUSIONS ALVSD is uncommon in individuals without previous clinical CVD, but it is associated with high risk for CHF, CVD, and all-cause mortality. The left ventricular mass index had good discrimination for incident CHF in Multi-Ethnic Study of Atherosclerosis (MESA) participants with ALVSD.
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Affiliation(s)
- Joseph Yeboah
- Department of Internal Medicine/Cardiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Clarke CJ, Gurka MJ, Norton PT, Kramer CM, Hoyer AW. Assessment of the accuracy and reproducibility of RV volume measurements by CMR in congenital heart disease. JACC Cardiovasc Imaging 2012; 5:28-37. [PMID: 22239890 DOI: 10.1016/j.jcmg.2011.05.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether right ventricular (RV) volumes are more accurately and reproducibly measured by cardiac magnetic resonance (CMR) in an axial orientation or in a short-axis orientation in patients with congenital heart disease (CHD). BACKGROUND There is little agreement on the most suitable imaging plane for RV volumetric analysis in the setting of abnormal RV physiology. METHODS Measurements of RV volumes from datasets acquired in axial and short-axis orientations were made in 50 patients with CHD. RV stroke volumes (SV) calculated using these 2 methods were compared with forward flow measured in the pulmonary trunk by phase contrast (PC) imaging. Repeated volume measurements were made to assess intraobserver and interobserver reliability. Bland-Altman plots and Lin's concordance correlation coefficient (CCC) were used for all analyses of agreement. RESULTS Analysis of all subjects revealed a statistically significant difference in interobserver reliability of RV end-systolic volume (ESV) measurements that favored the axial method (p = 0.047). The magnitude of measurement differences between observers in this case was small (-2.8 ml/m(2); 95% confidence interval: -5.6 to 0.0). There was no difference between the 2 contouring methods in terms of intraobserver reliability in measurements of RV end-diastolic volume (EDV), ESV, ejection fraction, or SV (p > 0.05 in all cases). In subjects with RV EDV ≥ 150 ml/m(2), RV SV measured using axial contours yielded better agreement with forward flow measured in the pulmonary trunk (CCC = 0.63) than did measurements made using short-axis contours (CCC = 0.56; p = 0.007). CONCLUSIONS Trends favoring the axial orientation in terms of reproducibility were not clinically significant. In subjects with RV EDV ≥ 150 ml/m(2), the axial orientation yields RV volume measurements that agree more closely with flow measured in the pulmonary trunk than does the short-axis orientation.
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Affiliation(s)
- Christopher J Clarke
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA.
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Increased enddiastolic wall stress precedes left ventricular hypertrophy in dilative heart failure—Use of the volume-based wall stress index. Int J Cardiol 2012; 157:233-8. [DOI: 10.1016/j.ijcard.2011.07.092] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/28/2011] [Accepted: 07/27/2011] [Indexed: 11/19/2022]
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Parikh NI, Lloyd-Jones DM, Ning H, Ouyang P, Polak JF, Lima JA, Bluemke D, Mittleman MA. Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2012; 163:470-6. [PMID: 22424019 DOI: 10.1016/j.ahj.2011.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling. METHODS Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education. RESULTS With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group. CONCLUSIONS Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.
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Tsao CW, Gona P, Salton C, Murabito JM, Oyama N, Danias PG, O'Donnell CJ, Manning WJ, Yeon SB. Relationship between central and peripheral atherosclerosis and left ventricular dysfunction in a community population. Vasc Med 2011; 16:253-9. [PMID: 21708875 DOI: 10.1177/1358863x11408640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to determine the relationships between resting left ventricular (LV) wall motion abnormalities (WMAs), aortic plaque, and peripheral artery disease (PAD) in a community cohort. A total of 1726 Framingham Heart Study Offspring Cohort participants (806 males, 65 ± 9 years) underwent cardiovascular magnetic resonance with quantification of aortic plaque volume and assessment of regional left ventricular systolic function. Claudication, lower extremity revascularization, and ankle-brachial index (ABI) were recorded at the most contemporaneous examination visit. WMAs were associated with greater aortic plaque burden, decreased ABI, and claudication in age- and sex-adjusted analyses (all p < 0.001), which were not significant after adjustment for cardiovascular risk factors. In age- and sex-adjusted analyses, both the presence (p < 0.001) and volume of aortic plaque were associated with decreased ABI (p < 0.001). After multivariable adjustment, an ABI ≤ 0.9 or prior revascularization was associated with a threefold odds of aortic plaque (p = 0.0083). Plaque volume significantly increased with decreasing ABI in multivariable-adjusted analyses (p < 0.0001). In this free-living population, associations of WMAs with aortic plaque burden and clinical measures of PAD were attenuated after adjustment for coronary heart disease risk factors. Aortic plaque volume and ABI remained strongly negatively correlated after multivariable adjustment. Our findings suggest that the association between coronary heart disease and non-coronary atherosclerosis is explained by cardiovascular risk factors. Aortic atherosclerosis and PAD remain strongly associated after multivariable adjustment, suggesting shared mechanisms beyond those captured by traditional risk factors.
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Affiliation(s)
- Connie W Tsao
- Harvard-Thorndike Laboratory and Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Di Bella G, Zito C, Gaeta M, Cusmà Piccione M, Minutoli F, Donato R, Recupero A, Madaffari A, Coglitore S, Carerj S. Semiautomatic quantification of left ventricular function by two-dimensional feature tracking imaging echocardiography. A comparison study with cardiac magnetic resonance imaging. Echocardiography 2011; 27:791-7. [PMID: 20597953 DOI: 10.1111/j.1540-8175.2009.01136.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of a semiautomatic quantification of left ventricular (LV) volumes and ejection fraction (EF) using two-dimensional (2D) feature tracking imaging (FTI). METHODS Thirty-four consecutive subjects (11 patients with dilated cardiomyopathy, 13 with hypertrophic cardiomyopathy, and 10 subjects with no cardiac disease) underwent, on the same day, trans-thoracic echocardiography (TTE) examination, FTI, and cardiac magnetic resonance imaging (MRI), as gold standard, in order to quantify LV volumes and EF. The echocardiographic quantification of LV volumes and EF was determined from four- and two-chamber views using both standard TTE Biplane Simpson's method and a semiautomatic border detection based on FTI. Furthermore, the time for data analysis for each method was measured. RESULTS The time required for semiautomatic analysis of volumes and EF was significantly lower (P < 0.0001) by FTI (71 seconds) in comparison with standard biplane Simpson's method (93 seconds). LV volumes obtained by FTI were significant underestimated (P < 0.001) in comparison with MRI. Bland-Altman analysis of EDV and ESV using FTI and cardiac MRI showed a low level of agreement for EDV (mean difference = 40.8; SD = 39) and ESV (mean difference = 38.1; SD = 42). On the contrary, no significant difference between FTI and MRI in assessing the LVEF was found; furthermore, a very low bias (2 ± 12) by Bland-Altman analysis was found between FTI and cardiac MRI for the quantification of EF. CONCLUSION Semiautomatic quantification of LV volumes using FTI allows an accurate, rapid, easy and reliable assessment of LV EF and a rough estimation of LV volumes.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
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Conti CA, Votta E, Corsi C, De Marchi D, Tarroni G, Stevanella M, Lombardi M, Parodi O, Caiani EG, Redaelli A. Left ventricular modelling: a quantitative functional assessment tool based on cardiac magnetic resonance imaging. Interface Focus 2011; 1:384-95. [PMID: 22670208 DOI: 10.1098/rsfs.2010.0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/01/2011] [Indexed: 01/15/2023] Open
Abstract
We present the development and testing of a semi-automated tool to support the diagnosis of left ventricle (LV) dysfunctions from cardiac magnetic resonance (CMR). CMR short-axis images of the LVs were obtained in 15 patients and processed to detect endocardial and epicardial contours and compute volume, mass and regional wall motion (WM). Results were compared with those obtained from manual tracing by an expert cardiologist. Nearest neighbour tracking and finite-element theory were merged to calculate local myocardial strains and torsion. The method was tested on a virtual phantom, on a healthy LV and on two ischaemic LVs with different severity of the pathology. Automated analysis of CMR data was feasible in 13/15 patients: computed LV volumes and wall mass correlated well with manually extracted data. The detection of regional WM abnormalities showed good sensitivity (77.8%), specificity (85.1%) and accuracy (82%). On the virtual phantom, computed local strains differed by less than 14 per cent from the results of commercial finite-element solver. Strain calculation on the healthy LV showed uniform and synchronized circumferential strains, with peak shortening of about 20 per cent at end systole, progressively higher systolic wall thickening going from base to apex, and a 10° torsion. In the two pathological LVs, synchronicity and homogeneity were partially lost, anomalies being more evident for the more severely injured LV. Moreover, LV torsion was dramatically reduced. Preliminary testing confirmed the validity of our approach, which allowed for the fast analysis of LV function, even though future improvements are possible.
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Affiliation(s)
- C A Conti
- Department of Bioengineering , Politecnico di Milano , Via Golgi 39, 20133 Milan , Italy
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Locca D, Bucciarelli-Ducci C, Ferrante G, La Manna A, Keenan NG, Grasso A, Barlis P, Del Furia F, Prasad SK, Kaski JC, Pennell DJ, Di Mario C. New Universal Definition of Myocardial Infarction. JACC Cardiovasc Interv 2010; 3:950-8. [DOI: 10.1016/j.jcin.2010.06.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 11/26/2022]
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Cardiac chamber quantification using magnetic resonance imaging at 7 Tesla--a pilot study. Eur Radiol 2010; 20:2844-52. [PMID: 20640427 DOI: 10.1007/s00330-010-1888-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/25/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Interest in cardiovascular magnetic resonance (CMR) at 7 T is motivated by the expected increase in spatial and temporal resolution, but the method is technically challenging. We examined the feasibility of cardiac chamber quantification at 7 T. METHODS A stack of short axes covering the left ventricle was obtained in nine healthy male volunteers. At 1.5 T, steady-state free precession (SSFP) and fast gradient echo (FGRE) cine imaging with 7 mm slice thickness (STH) were used. At 7 T, FGRE with 7 mm and 4 mm STH were applied. End-diastolic volume, end-systolic volume, ejection fraction and mass were calculated. RESULTS All 7 T examinations provided excellent blood/myocardium contrast for all slice directions. No significant difference was found regarding ejection fraction and cardiac volumes between SSFP at 1.5 T and FGRE at 7 T, while volumes obtained from FGRE at 1.5 T were underestimated. Cardiac mass derived from FGRE at 1.5 and 7 T was larger than obtained from SSFP at 1.5 T. Agreement of volumes and mass between SSFP at 1.5 T and FGRE improved for FGRE at 7 T when combined with an STH reduction to 4 mm. CONCLUSIONS This pilot study demonstrates that cardiac chamber quantification at 7 T using FGRE is feasible and agrees closely with SSFP at 1.5 T.
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Nutzen telemedizinischer Netzwerke für die kardiovaskuläre Forschung: MR-Bildgebung angeborener Herzfehler als Beispiel. KARDIOLOGE 2010. [DOI: 10.1007/s12181-010-0270-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical Value of Real-Time Three-Dimensional Echocardiography for Right Ventricular Quantification in Congenital Heart Disease: Validation With Cardiac Magnetic Resonance Imaging. J Am Soc Echocardiogr 2010; 23:134-40. [DOI: 10.1016/j.echo.2009.12.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Indexed: 11/16/2022]
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Govind SC, Gadiyaram VK, Quintana M, Ramesh SS, Saha S. Study of Left Ventricular Rotation and Torsion in the Acute Phase of ST-Elevation Myocardial Infarction by Speckle Tracking Echocardiography. Echocardiography 2010; 27:45-9. [DOI: 10.1111/j.1540-8175.2009.00971.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ko SM, Kim YJ, Park JH, Choi NM. Assessment of left ventricular ejection fraction and regional wall motion with 64-slice multidetector CT: a comparison with two-dimensional transthoracic echocardiography. Br J Radiol 2010; 83:28-34. [PMID: 19546180 PMCID: PMC3487259 DOI: 10.1259/bjr/38829806] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 02/15/2009] [Accepted: 02/19/2009] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to compare the measurement of left ventricular ejection fraction (LVEF) and regional wall motion using 64-slice multidetector CT (MDCT) with that using two-dimensional transthoracic echocardiography (2D-TTE) in a heterogeneous patient population. In 126 patients with angina pectoris, acute myocardial infarction, chronic myocardial infarction, atypical chest pain without coronary artery disease or valvular heart disease, 64-slice MDCT was performed using retrospective electrocardiography gating without dose modulation. 20 phases of the cardiac cycle were analysed to identify the end-diastolic and end-systolic phases and to assess regional LV wall motion. For these measurements, 2D-TTE served as the reference standard. MDCT and 2D-TTE were performed within 10 days of each other. An excellent correlation between MDCT and 2D-TTE was shown for the evaluation of LVEF (59.2+/-11% vs 57.9+/-10%, respectively; r = 0.87). LVEF was slightly overestimated by MDCT, when compared with 2D-TTE, by an average of 1.4+/-5.6%. Good agreement was obtained between the use of the two techniques, with 94% of the segments scored identically on both modalities (kappa = 0.70). MDCT had a sensitivity of 97% and a specificity of 82% when compared with 2D-TTE as the reference standard. In conclusion, the use of 64-slice MDCT can provide comparable results to those using 2D-TTE for LVEF and regional wall motion assessment in a heterogeneous population.
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Affiliation(s)
- S-M Ko
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea.
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Lehrke S, Steen H, Kristen AV, Merten C, Lossnitzer D, Dengler TJ, Katus HA, Giannitsis E. Serum levels of NT-proBNP as surrogate for cardiac amyloid burden: new evidence from gadolinium-enhanced cardiac magnetic resonance imaging in patients with amyloidosis. Amyloid 2009; 16:187-95. [PMID: 19922329 DOI: 10.3109/13506120903421538] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The prognostic value of NT-proBNP has been recognized in patients with amyloidosis complicated by cardiac involvement. We aimed to use contrast enhanced cardiac magnetic resonance imaging (CMR) to identify functional and structural alterations related to levels of NT-proBNP better to understand the mechanisms of its release in cardiac amyloidosis. METHODS AND RESULTS CMR was performed on a 1.5-T scanner in 34 patients with biopsy proven amyloid light chain (AL; n = 27) or hereditary transthyretin related (TTR; n = 7) amyloidosis. NT-proBNP was higher in patients with (n = 25) compared to patients without cardiac involvement (n = 9) (2931 (IQR: 972-8629; min-max: 25-27,277) pg/ml vs. 177 (IQR: 71-1431; min-max: 22-7935) pg/ml, p = 0.008). ROC analysis identified a NT-proBNP of <2426.5 pg/ml as optimal discriminator for event free survival (682 +/- 65 days). NT-proBNP did not correlate with LV- ejection fraction, end-diastolic and end-systolic volumes or stroke volume. There was a moderate correlation between NT-proBNP and LV-mass (R = 0.52, p = 0.003) and extent of late gadolinium enhancement (LGE; R = 0.41, p = 0.04). CONCLUSIONS This study confirms the prognostic value of NT-proBNP in patients with AL and TTR amyloidosis and provides the novel finding that NT-proBNP correlates with surrogates of myocardial amyloid burden such as LV-mass and LGE, supporting the concept of NT-proBNP as a biomarker reflecting the severity of cardiac amyloid infiltration.
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Affiliation(s)
- Stephanie Lehrke
- Department of Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
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Beerbaum P, Barth P, Kropf S, Sarikouch S, Kelter-Kloepping A, Franke D, Gutberlet M, Kuehne T. Cardiac function by MRI in congenital heart disease: Impact of consensus training on interinstitutional variance. J Magn Reson Imaging 2009; 30:956-66. [DOI: 10.1002/jmri.21948] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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The gold standard for noninvasive imaging in coronary heart disease: magnetic resonance imaging. Curr Opin Cardiol 2009; 24:567-79. [DOI: 10.1097/hco.0b013e3283315553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Keenan NG, Mason JC, Maceira A, Assomull R, O'Hanlon R, Chan C, Roughton M, Andrews J, Gatehouse PD, Firmin DN, Pennell DJ. Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. ACTA ACUST UNITED AC 2009; 60:3501-9. [DOI: 10.1002/art.24911] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rijzewijk LJ, van der Meer RW, Lamb HJ, de Jong HWAM, Lubberink M, Romijn JA, Bax JJ, de Roos A, Twisk JW, Heine RJ, Lammertsma AA, Smit JWA, Diamant M. Altered myocardial substrate metabolism and decreased diastolic function in nonischemic human diabetic cardiomyopathy: studies with cardiac positron emission tomography and magnetic resonance imaging. J Am Coll Cardiol 2009; 54:1524-32. [PMID: 19815124 DOI: 10.1016/j.jacc.2009.04.074] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 04/17/2009] [Accepted: 04/23/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study was designed to evaluate myocardial substrate and high-energy phosphate (HEP) metabolism in asymptomatic men with well-controlled, uncomplicated type 2 diabetes with verified absence of cardiac ischemia, and age-matched control subjects, and to assess the association with myocardial function. BACKGROUND Metabolic abnormalities, particularly an excessive exposure of the heart to circulating nonesterified fatty acids and myocardial insulin resistance are considered important contributors to diabetic cardiomyopathy in animal models of diabetes. The existence of myocardial metabolic derangements in uncomplicated human type 2 diabetes and their possible contribution to myocardial dysfunction still remain undetermined. METHODS In 78 insulin-naive type 2 diabetes men (age 56.5 +/- 5.6 years, body mass index 28.7 +/- 3.5 kg/m(2), glycosylated hemoglobin A(1c) 7.1 +/- 1.0%; expressed as mean +/- SD) without cardiac ischemia and 24 normoglycemic control subjects (age 54.5 +/- 7.1 years, body mass index 27.0 +/- 2.5 kg/m(2), glycosylated hemoglobin A(1c) 5.3 +/- 0.2%), we assessed myocardial left ventricular (LV) function by magnetic resonance imaging, and myocardial perfusion and substrate metabolism by positron emission tomography using H(2)(15)O, carbon (11)C-palmitate, and 18-fluorodeoxyglucose 2-fluoro-2-deoxy-D-glucose. Cardiac HEP metabolism was assessed by phosphorous P 31 magnetic resonance spectroscopy. RESULTS In patients, compared with control subjects, LV diastolic function (E/A ratio: 1.04 +/- 0.25 vs. 1.26 +/- 0.36, p = 0.003) and myocardial glucose uptake (260 +/- 128 nmol/ml/min vs. 348 +/- 154 nmol/ml/min, p = 0.015) were decreased, whereas myocardial nonesterified fatty acid uptake (88 +/- 31 nmol/ml/min vs. 68 +/- 18 nmol/ml/min, p = 0.021) and oxidation (85 +/- 30 nmol/ml/min vs. 63 +/- 19 nmol/ml/min, p = 0.007) were increased. There were no differences in myocardial HEP metabolism or perfusion. No association was found between LV diastolic function and cardiac substrate or HEP metabolism. CONCLUSIONS Patients versus control subjects showed impaired LV diastolic function and altered myocardial substrate metabolism, but unchanged HEP metabolism. We found no direct relation between cardiac diastolic function and parameters of myocardial metabolism.
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Affiliation(s)
- Luuk J Rijzewijk
- Diabetes Center, VU University Medical Center, Amsterdam, the Netherlands
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Sarikouch S, Peters B, Gutberlet M, Leismann B, Kelter-Kloepping A, Koerperich H, Kuehne T, Beerbaum P. Sex-specific pediatric percentiles for ventricular size and mass as reference values for cardiac MRI: assessment by steady-state free-precession and phase-contrast MRI flow. Circ Cardiovasc Imaging 2009; 3:65-76. [PMID: 19820203 DOI: 10.1161/circimaging.109.859074] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac MRI is important in the treatment of children with congenital heart disease, but sufficient normative data are lacking. For ventricular volumes and mass, we sought to deliver reference centiles and to investigate sex effects. METHODS AND RESULTS We included 114 healthy children and adolescents, uniformly distributed spanning an age range of 4 to 20 years, as required by the Lambda-Mu-Sigma method to achieve a percentile distribution, thus avoiding arbitrary age categories. Subjects underwent axial volumetry (1.5-T scanner) using standardized 2D steady-state free-precession and flow protocols. Percentiles were computed for age 8 to 20 years (99 subjects) because breath-holds were more consistent in this group. When indexed for body surface area or height, the centile curves of ventricular volumetric parameters showed allometric increase until adolescence, when a plateau was reached, with values comparable to published adult reference data. In contrast, ventricular mass centiles increased without plateau. There was a significant sex difference, with centiles reflecting larger values in boys than in girls (P<0.05) when ventricular volumes were indexed to body surface area or height but not when indexed to weight (exception: mass). There was excellent agreement of axial and short-axis volumetry and of volumetric and flow-derived stroke volumes. CONCLUSIONS Percentiles for ventricular volumes and mass in healthy children have been established to serve as reference values in pediatric heart disease. Significant sex differences were noted when indexing volumes to body surface area or height. Unisex centiles related to weight may be considered for chamber volumes albeit not for mass.
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Affiliation(s)
- Samir Sarikouch
- Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Connelly KA, Detsky JS, Graham JJ, Paul G, Vijayaragavan R, Dick AJ, Wright GA. Multicontrast late gadolinium enhancement imaging enables viability and wall motion assessment in a single acquisition with reduced scan times. J Magn Reson Imaging 2009; 30:771-7. [DOI: 10.1002/jmri.21907] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nakano EM, Shigueoka DC, Szarf G, Pinetti RZ, Santos JEM, Szejnfeld D, Barbieri A. Avaliação da função ventricular esquerda pela sequência de ressonância magnética sem apneia e com múltiplas excitações. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000500006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a eficácia da sequência de ressonância magnética com três excitações, para obtenção de volumes e massas ventriculares, em indivíduos com respiração livre, sem apneia. MATERIAIS E MÉTODOS: Em 32 voluntários sadios, foram comparados os volumes e massas do ventrículo esquerdo, obtidos por meio de duas sequências de ressonância magnética em modo cine. A primeira, tradicionalmente utilizada e considerada padrão, em apneia e com excitação única, e a segunda, em respiração livre e com três excitações. Três leitores, com diferentes níveis de experiência, testaram a concordância e a reprodutibilidade. Para a análise estatística foram utilizados o coeficiente de correlação intraclasse, o teste t-pareado, os gráficos de Bland-Altman e o teste do sinal. RESULTADOS: Para os dois observadores mais experientes, os coeficientes de correlação intraclasse foram superiores a 0,913, assim como os níveis descritivos do teste t-pareado acima de 0,05, os gráficos de Bland-Altman com as diferenças distribuídas aleatoriamente em torno do zero e o teste do sinal com seu nível descritivo superior a 0,05. CONCLUSÃO: A sequência testada apresenta ótima concordância e reprodutibilidade em relação à sequência padrão, podendo ser aplicada em indivíduos com limitações respiratórias.
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Affiliation(s)
| | | | | | - Rogério Zaia Pinetti
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de São Paulo, Brasil
| | | | - Denis Szejnfeld
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de São Paulo, Brasil
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Cardiac image modeling tool for quantitative analysis of global and regional cardiac wall motion. Invest Radiol 2009; 44:271-8. [PMID: 19346964 DOI: 10.1097/rli.0b013e31819c96e3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the Cardiac Image Modeling (CIM 4.6; University of Auckland, Auckland, New Zealand) tool's ability to assess cardiac function via quantitative calculations of global and regional ejection fraction (EF) from magnetic resonance imaging in comparison with a current method of global analysis with Argus (Siemens Medical Solutions) and regional analysis with visual analysis. BACKGROUND Global cardiac function is commonly assessed quantitatively by post processing tools that calculate global EF. Currently, regional cardiac function is assessed by subjective visual analysis of wall motion, which can have significant interobserver variability. CIM is a tool that may reduce variability by generating a semi-automated 3-dimensional heart model to calculate quantitative global and regional EF. MATERIALS AND METHODS Thirty-one patients (22 men, 9 women; mean age 55.1 +/- 17.5 years) were selected based on global EFs calculated at the time of the clinical visit with the Argus postprocessing tool (Siemens Medical Solutions). Patients were then placed into 2 predetermined categories of normal: EF >or=50% and abnormal: EF <50%. Regional EF was calculated for each segment of a 16-segment cardiac model. Three blinded reviewers used the standard of care assessment of regional function, which was a qualitative grading of the 16 segments into categories of normal or abnormal regional wall motion by visual analysis. CIM quantitatively analyzed global EF and regional EF for each segment. These segments were then sorted into the predetermined categories of normal (EF >or=50%) and abnormal (EF <50%). Level of agreement was conducted via Pearson correlation coefficient and Bland-Altman analysis for global EF analysis and observed proportion of agreement (p(a)), sensitivity, and specificity for regional EF analysis. RESULTS Global EF analysis showed a high correlation (r2 = 0.85; y = 0.94x + 4.85, P < 0.001) between the Argus and CIM analyses. Sixteen-segment regional EF analysis showed p(a) averages >0.60. Regional wall motion by short axis slices showed pa averages >0.75, and combined analyses of all 3 reviewers' 16-segment regional data showed an overall total p(a) = 0.79 (sensitivity = 72%, specificity = 88%). Interobserver and intraobserver variability were low (p(a) > 0.65) in this study. CONCLUSIONS Global EF analysis of cardiac magnetic resonance imaging by CIM showed high agreement with the commonly used Argus postprocessing tool. Furthermore, CIM is capable of evaluating regional EF with good agreement in comparison with the current visual method. In addition to determining abnormal versus normal cardiac wall motion, CIM is able to add to the analysis a quantitative regional EF for each given segment. As a semi-automated tool, CIM has the potential to reduce reviewer variability and decrease the time required for analysis. In the future, CIM can potentially quantitatively track global and regional changes in patients with heart disease and aid the clinical management throughout the course of the disease.
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Clerico A, Vittorini S, Passino C, Emdin M. New and emerging biomarkers of heart failure. Crit Rev Clin Lab Sci 2009; 46:107-28. [DOI: 10.1080/10408360902722342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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